Factors affecting nurse practitioners' integration of evidence into practice

Abstract

Background: Evidence-based clinical practice guidelines bridge the gap between clinical practice and research, improve patient outcomes, promote consistency of care, and enhance quality of care. However, guideline adherence varies widely among individual providers and organizations. Purpose: To identify factors that facilitate or impede nurse practitioners' integration of guideline recommendations into practice. Methods: Every nurse practitioner in Alabama was invited to complete an online 45-question survey evaluating beliefs and attitudes regarding evidence-based guidelines, facilitators and barriers to implementation, and utilization of information resources in patient care. Results: The five most commonly identified barriers to evidence-based guideline implementation in participants' current work settings are patients with multiple comorbidities, time constraints, pressure from patients to provide nonrecommended care, insufficient staffing, and inadequate financial resources. The five most commonly identified facilitators in participants' current work settings are easy access to guidelines, support from leadership, free access to guidelines, in-person education regarding a guideline, and clinical decision support software programs. Participants expressed a desire for free and easy access to evidence-based practice (EBP) guidelines and clinical decision support programs, as well as education regarding guidelines and opportunities to discuss evidence with colleagues. Implications for practice: The barriers and facilitators of guideline implementation that were identified in this study should be useful in the development and refinement of future studies and interventions to enhance guideline implementation among individuals and organizations.

Advanced practice nurses' evidence‐based healthcare competence and associated factors: A systematic review

“…APNs believed that EBP positively affected patient outcomes (Alshammari et al., 2021; Bhatarasakoon et al., 2022; Butler, 2011; Campbell, 2012; Gerrish et al., 2011: Hamilton et al., 2022; Harper et al., 2017; Malik et al., 2015; Van Roper, 2011) and led to the best clinical care (Butler, 2011; Campbell, 2012; Gerrish et al., 2011; Hamilton et al., 2022; Harper et al., 2017; Profetto‐McGrath et al., 2010). They felt that evidence‐based practice is fundamental to professional practice (Bhatarasakoon et al., 2022; Hamilton et al., 2022). One of their strongest EBP competencies was questioning clinical practice (Harper et al., 2017) but they rarely used evidence to make or develop research proposals (Campbell, 2012; Profetto‐McGrath et al., 2010).…”

“…Inspection of the background data showed that although the reviewed studies focused on APNs, who in principle must hold at least a master's degree, there were only three studies in which all participants had this level of education (Butler, 2011; Hamilton et al., 2022; Woo et al., 2019). The levels of education in the other studied populations were variable and, in some cases, extremely low.…”

“…A total of 3163 respondents participated in the selected studies. The Competence in individual EBHC stages was measured using the Evidence-Based Practice Implementation (EBPI) scale, the Evidence-Based Practice Belief (EBPB) scale (Butler, 2011;Harper et al, 2017;Van Roper, 2011), the Evidence-Based Practice Questionnaire (EBPQ) scale (Alshammari et al, 2021;Bhatarasakoon et al, 2022), the Health Science-Evidence-Based Practice (HS-EBP) questionnaire (Hamilton et al, 2022), the Evidence-Based Education Questionnaire (EBEQ) scale (Hellier & Cline, 2016), the EBP competency measure (Harper et al, 2017), the PREVIEW measure of specialty competency (Van Roper, 2011), a measure developed by Profetto-McGrath (Campbell, 2012;Profetto-McGrath et al, 2010), the Development of Evidence-Based Practice questionnaire, (Gerrish et al, 2011;Malik et al, 2015), the Attitudes to Evidence-Based Practice questionnaire, the Clinical Effectiveness and Evidence-Based Practice Questionnaire (Malik et al, 2015), the Advanced Practice Role Delineation (APRD) tool, National Survey of Primary Care NPs and Physician and the Practice Pattern Survey (Woo et al, 2019).…”

An Integrative Review of Response Rates in Nursing Research Utilizing Online Surveys

“…The participant is then asked to access a web-based survey via a QR code. Hamilton et al (2022) sent postcards to a list of 5,242 NPs in Alabama to yield a sample of 150 participants (response rate of 2.86%), and DeClerk et al (2022) sent 2,566 postcards to NPs in Arkansas to yield a sample of 277 participants (10.8%). Both examples have a large participant pool and reasonable sample size, yet low response rates.…”

Challenging Barriers: Registered Nurses’ Association of Ontario (RNAO) Clinical Practice Guidelines and Organizational Change

“…Investigaciones hasta 2020 contextualizan las barreras en cinco contextos: Político-Social, Organizacional, profesional (41,42,43,44,45,46) y en el contexto del paciente, (42,43,44,47,48) y en el contexto de las directrices de las guías. (41,42,43,44,45,46) Desde la perspectiva de enfermería, estas barreras plantean obstáculos significativos que afectan directamente la capacidad de los profesionales de la salud para brindar una atención basada en la evidencia y centrada en el paciente.…”